Purpose. To study the potential of non-invasive assessment of cerebral blood flow autoregulation (CA) using cross-spectral analysis of slow dopplerographic patterns. Materials and methods. The study involved 40 healthy volunteers and 228 patients with different neurosurgical pathology: cerebral aneurysm - 50 cases, arteriovenous malformation - 52, traumatic brain injury - 61, communicating hydrocephalus - 24, parasagittal meningioma - 20, stenosis and thrombosis of the carotid arteries - 21. Blood flow velocity (BFV) in middle cerebral arteries was monitored using Multi Dop X (DWL, Germany), systemic blood pressure (BP) - noninvasively with Finapres (Ohmeda 2100 USA) within 4 minutes. CA was assessed by calculating the phase shift (PSM) between spontaneous slow oscillations of BP and BFV within the range of systemic Mayer waves (80-120 mHz) and amplitude of intracranial B-waves of BFV (AB) within the range from 8 to 50 mHz). Results and discussion. CA demonstrated different patterns in neurosurgical patients and varied from normal autoregulation to its complete absence. This indicates the degree of compensation of cerebral hemodynamics in pathological conditions such as intracranial hypertension, vasospasm, traumatic edema, ischemia, abnormal arteriovenous shunting. On the basis of perioperative evaluation of PSM and AB, the predictors of efficacy and outcome have been identified in patients with cerebral aneurysms in an acute period of hemorrhage, severe brain injury, cerebral arteriovenous malformations and communicating hydrocephalus. Conclusions. Analysis of slow-wave dopplerographic patterns of BFV in intracranial cerebral arteries and BP is informative, adequate, safe non-invasive way to assess CA in normal and pathological conditions. Perioperative assessment of these patterns can be used to predict the effectiveness of treatment in patients with different neurosurgical pathology.

Purpose. The aim of this study was to evaluate the microcirculation in patients with acute coronary syndrome over the course of the disease. Design/methodology/approach. 48 patients were examined with average age of 65.3±5.1 years. The patients were delivered in an intensive care unit with a diagnosis of acute coronary syndrome. Analysis of clinical, instrumental and laboratory parameters was made depending on the final diagnosis: «myocardial infarction» - 26 patients, «unstable angina» - 22 patients. In addition, both linear and volume blood flow were evaluated on the distal phalanx of second finger of the right hand in all patients using the method of high-frequency (25 MHz) ultrasound Doppler study. Findings. At admission, in patients with acute myocardial infarction the linear velocity of blood flow was 10.27±1.18 mm/s, the volume rate of flow 4.67±0.55 ml/min; in the subgroup of patients with unstable angina these figures were 14.09±1.50 mm/s and 6.64±0.71 ml/min, respectively (p<0.05). After 12-24 hours on a background of the therapy in patients with myocardial infarction an increase of the studied parameters is registered (12.3±1.7 mm/s and 6.33±0.96 ml/min for linear and volumetric blood flow velocity). The inverse correlations between the indices of the peripheral circulation and the size of the left and right atria, and end-diastolic size of left ventricular were identified. Originality/value. Patients with acute myocardial infarction in the start of disease showed significantly lower rates of microcirculation with their subsequent growth, in comparison with the patients with unstable angina, where the opposite dynamic is registered at the initially higher values of the microcirculation. The statistical correlation analysis was made. In patients with acute coronary syndrome it defined a reverse reliable link of microcirculation parameters with the end-diastolic size of the left ventricle, the size of the left and right atrium, as well as the level of sodium in blood plasma.

According to the modern statistics, the isolated atherosclerotic lesion in one arterial region occurs twice less often, than the combined lesion in several regions. Among the last, significant stenoses (>50 %) make up to 25 % of cases. Vascular surgeons need high-informative and noninvasive diagnostic methods for detection of way of surgical treatment of these lesions. So far the X-ray contrast angiography (AG) remains a method of «the gold standard» whereas the screening part is assigned to the duplex scanning (DS). The aim of present study was to compare results of ultrasonic DS and angiography in patients with multifocal atherosclerosis. Sensitivity and specificity of these methods had been evaluated. By means of screening of 565 men of 45-59-years-old, 64 patients with multifocal atherosclerotic lesions in coronary, carotid and low extremity arteries were identified. They were examined using DS and AG. The degree of carotid stenosis was accurately measured both by means of ultrasonic duplex scanning and angiography. Sensitivity and specificity of DS were 86 and 71 %, sensitivity of AG was 97 %, specificity was 86 %. Furthermore duplex scanning provided more information in detecting of unstable plaques compared with angiography. Thus ultrasound diagnostic may be considered a useful method for detecting different characteristics of multifocal atherosclerotic lesion, including the preoperative noninvasive assessment.

Relevance. Pulmonary sequestrations are rare pathology and make from 0.15 to 6.4 % of all congenital abnormality. Thus intra-abdominal localization of this malformation is described only in 2.5 % of all pulmonary sequestrations. Objective. Reflect the difficulty of differential diagnosis of rare lung malformation in newborns. Materials and methods. 2 cases of the extralobar sequestration located under the diaphragm diagnosed for newborns in a children's hospital for the last 20 years are in details described. Results. The diagnosis of an intra-abdominal extralobular pulmonary sequestration was finalized only after surgical treatment, confirmed histologically. Questions of differential diagnostics of rare congenital pulmonary malformations are discussed with tumors of suprarenal localization at newborns, comparison of own results to data of literature. Conclusions. In the differential diagnosis of suprarenal lesions at newborns it is necessary to consider the possibility of intra-abdominal extralobar pulmonary sequestration, especially in the localization of pathological changes at the left side.

Modern angiographic and stressful ultrasonic technologies possess the big possibilities in diagnostics of the latent coronary insufficiency. Purpose. To compare sensitivity and specificity of bicycle stress-echocardiography, dopplerography of coronary arteries and combined method in diagnostics of significant stenosis of coronary arteries were used. Design/methodology/approach. Two groups of patients were analyzed: 35 persons from more than 50 % stenosis of coronary arteries and 39 persons without significant stenosis. Dopplerography of coronary arteries and stress-echocardiography were performed in all patients. The ROC-analysis of sensitivity and specificity of each method and the combined technology in diagnostics of the general CAD, left anterior-descending CAD, and the right coronary CAD was spent. Findings. The dopplerography of coronary arteries has shown sensitivity of 77 %, specificity of 97 %, for LAD - 81 and 97 %, for RA - 50 and 98 %. The stress-echocardiography has shown sensitivity of 83 %, specificity of 95 %, for LAD - 89 and 95 %, for RA - 63 and 98 % The combined technique has shown sensitivity of 93 %, specificity - 95 %, for LAD - 96 and 94 %, for RA - 75 and 98 %. Conclusion. The combined technique is characterized by the robust reproducibility at the expense of revealing of loading infringements local contractility of myocardium in patients with not detected stenosis, and also at the expense of revealing of vascular narrowing in persons with well developed indemnification of deficiency of a blood-groove on the changed vessel.

Introduction. Assessment of microcirculation by laser Doppler flowmetry (LDF) is widely applied in clinical medicine. Though, it is important to highlight the difficulty of getting stable results of LDF in the skin microvessels and their interpretation in patients with arterial hypertension (AH). This study was undertaken to address this issue. Results and discussion. Based on both available literature and our data, high functional dynamics and individual characteristics of microcirculation (MC) parameters and spatial heterogeneity of mircovascular (MV) channel was demonstrated. Interpretation difficulties of research results, connected to these factors, can be eliminated using certain methodology. Incorrect interpretation of MC parameters can be caused by ignorance of central hemodynamics features, with no estimation of bloodstream distribution. Conclusion. Consideration of the listed factors will allow to receive more accurate physiological interpretation of MC parameters in the skin - the most reachable object in clinical conditions.

Objective. The aim of the study was description of the method of skin blood flow imaging via spectral processing of the dynamic thermograms of extremities. Materials and methods. The method realized by decomposition of the temperature signal into spectral components, modification of the spectral components and inverse transform of the spectral components into a new signal, which is considered as blood flow. Modification of spectral components was accomplished taking into account skin properties, and intended for the compensation of attenuation and time lag of temperature spectral components relative to blood flow components. Results. Blood flow maps of hands during arm cuff test have been demonstrated. Blood flow values calculated from the dynamic thermogram have been validated by photoplethysmography. The technique allows restoring of the blood flow oscillations at any point of the thermogram of the object. Benefits of thermal imaging of blood flow are the following: results are not depended from the ambient light, the method not critical to the camera angle, and blood flow maps can be registered both from the whole body and small areas. The method of blood flow imaging, in a long view, applicable for the monitoring of the skin microcirculation in progression and treatment of diabetic foot syndrome, Raynaud's syndrome, as well as burn, frostbite, mechanical injury, and atherosclerosis.

Introduction. The best diagnostic approach for early detection of vascular remodeling in prenosological stage of development the main cardiovascular (CV) diseases has not yet been determined, which inhibits effective vascular screening in the youth population. Objective of the present study was to assess the possible impact of risk factors (RF) on central aortic pressure (CAP) and its augmentation index in young age. Materials and Methods. A total of 80 students (38 girls, 42 boys) were examined in University Center of Student's Health for the presence of major cardiovascular RF and evaluation of CAP in the office format using diagnostic complex BPLab (company «Peter Telegin», Nizhny Novgorod, Russia) on technology Vasotens. In addition to BP in the brachial arterial (BA), the systolic aortic BP (SYSao), diastolic aortic BP (DIAao), index of augmentation in aorta (AIxao), pulse pressure amplification (PPA) and other parameters were analyzed. Surveyed persons were divided into two groups, taking into account the lack of RF ( 26 persons ) and their presence (54 persons). Results. Statistically significant increase in systolic, pulse, average pressure in the aorta and index of augmentation of pulse pressure was revealed in persons with cardiovascular RFs in comparison with those without the specified RFs. Among peripheral hemodynamic parameters, significant difference between the groups was is noted in the value of average pressure. The profile of various options of increase CAP in students as systemic, hidden and false prehypertension / hypertension substantially depends on presence of RF. Conclusion. Obtained data have confirmed the idea about valuability of using the assessment of CAP in Centers of youth's health and Student's policlinics when carrying checkups for the purpose of early detection of CV risk among young people and timely conduct personalized measures for prevention.

Experience of surgical and complex treatment more than 2500 patients with the purulent and necrotic complications of various forms of a diabetic foot syndrome was generalized. The number of such patients in our unit for the last fifth anniversary in comparison with previous years was doubled. At an ischemic form vasodilating complex therapy was carried out. At the femoral and popliteal block with a limited distal necrosis autovenous shunting with the subsequent economical necretomy was carried out, without sending of the patient from the septic surgical unit. In a case of the neuropathic form of a diabetic foot syndrome drainage of suppurative focuses, economical and sometimes repeated necretomies at various levels of the foot was made. It allowed us to keep foot of the patient for an extremity support in 80 % of the all cases. Frequency of high amputations in recent years was reduced, at the level of a femur from 13 to 1.4 %, at the level of a shin - from 11.5 to 5.8 %. In diagnostics, operation scoping and an assessment of effectiveness of treatment, researches of microcirculation by means of the device «Minimax-Doppler-К» were used. When the indexes of the peripheral speed of a linear bloodflow more than 1.6 mm/sec and rate of volume flow more than 0.0128 ml/min reamputation was not required.

Purpose. The wide range of the factors promoting emergence of GLD and also specificity of racial features of this disease testify to importance of studying of the genetic reasons of hereditary predisposition to development of GLD. Design/methodology/approach. PCR-RFLP analysis of the studied polymorphism of genes associated with the formation method of lipodystrophy, and estimated of genetic testing results. Findings. There is a correlation between GLD and allelic variants of genes (MMP3, ACE, NOS3), whose products are involved in collagen metabolism, and the cardiovascular system by regulating blood microcirculation the violation of which plays the essential role in the development of GLD. Practical implications. These results suggest the use of treatment aimed at solving the problems of the microcirculation is important for the treatment of patients with GLD.

Cerebral blood vessel reactivity is one of the main determinants of final outcome of brain ischemia. Most of studies on the vascular mechanisms of ischemic brain injury, however, focus on the acute changes within ischemic period or several hours after it. Dilatatory capacity of cerebral arterioles (perfusion reservoir) is considered as an important factor of brain perfusion elevation in critical situations.The aim of the present study was to examine the pial vessel reactivity in response to hypercapnia in rats, subjected to transient global cerebral ischemia, at 7, 14 and 21 days after ischemia. Materials and methods. Transient global cerebral ischemia was induced in anesthetized Wistar rats by bilateral common carotid artery occlusion for 12 min with simultaneous controlled hypotension to 45±3 mm Hg, followed by blood reinfusion and recovery from anesthesia. Three different groups of rats were re-anesthetized at 7, 14 or 21 days after ischemia and subjected to microvascular reactivity studies using in vivo video microscopy. Hypercapnia was caused by i.v. injection of acetazolamide. The changes in diameter of pial arteries and veins in response to hypercapnia were measured. Results and discussion. Global cerebral ischemia led to marked decrease in pial vessels (both arteries and veins) reactivity in response to hypercapnia, caused by i.v. injection of acetazolamide. In intact rats, i.v. injection of acetazolamide led to pial arteries dilation and pial veins constriction; in animals subjected to ischemia-reperfuion. the numbers of dilated large arteries and constricted small veins were much less, as well as the extent of arterial dilation. Reactivity changes were observed in all time points studied. Conclusions. Thus, transient global cerebral ischemia cause marked and long lasting (3 weeks) decrease in pial vessel reactivity in response to hypercapnia.